The URL can be used to link to this page

12-163.00 AAA SweepingCITI' OF Spokane ,,,;,00wValley DEPARTMENT OF PUBLIC WORKS CHANGE ORDER TO CONSTRUCTION CONTRACT NO: 12 -003 PROJECT: 2012 Storm Drain Cleaning Services CONTRACT DATE: 11- May -12 CONTRACTOR: AAA Sweeping, LLC CHANGE ORDER NO: 1 SCHEDULE A - PROJECT NO: 12 -003 SCHEDULE B - DESCRIPTION OF CHANGES 1. Extension of hours to complete additional storm drain cleaning on backlog. Total Amount of this Change Order: $10,000.00 SUBSTANTIAL COMPLETION Original Date: 12/31/2012 Prior to this Change Order: Including this Change Order: 12/31/2012 THESE CHANGES RESULT IN THE FOLLOWING ADJUSTMENTS OF CONTRACT PRICE: ORIGINAL CONTRACT AMOUNT $ 189,990 ..............................................................................,,,,,,.,.................................................................................................................................... ............................... TOTAL PRIOR CHANGE ORDER AMOUNT $ 0 .................................................................................................................................................................. ............................... CONTRACT PRICE PRIOR TO THIS CHANGE ORDER (through CO #) $ 189,990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . NET THIS CHANGE ORDER $ 10,000 .................................................................................................................................................................................................................. ............................... CONTRACT AMOUNT INCLUDING THIS CHANGE ORDER $ 199,990 CONTRACTOR ACCEPTANCE: DATE: The contractor hereby accepts this adjustment nder the terms of the original contract for all work perfomed. RECOMMENDED B APPROVED BY: APPROVED BY: ATTACHMENTS: Distribution: V I . uth, Public ORIGINALS TO: Contractor, City of Spokane Valley Clerk's Office, PW Project File COPIES TO: RPW /Forms/Templates /CO (Nov 06) DATE: Z 27 C c-r ZO�Z DATE: (/ /Z- DATE: to 2 Z-- 193565 E DATE (MM /DD/YYYY) 10/15/2012 THE CERTIFICATE HOLDER. THIS iE AFFORDED BY THE POLICIES WING INSURER(S), AUTHORIZED ROGATION IS WAIVED, subject to ficate does not confer rights to the SUER FAX 866- 510 -9588 Om VERAGE NAIC # ance Company 10804 X X CWP2895788 10/19!12 10!19/13 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISE occurrence $ 300,000 MED EXP (Any one person) ION NUMBER: See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE_ FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSR SUER POLICY NUMBER MM/DD/YYYY MMIDDfYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FxI OCCUR X WA STOP GAP X X CWP2895788 10/19!12 10!19/13 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISE occurrence $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- LICY [_X] PC LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ • AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUT OS AUTOS NON -OWNED X HIRED AUTOS X AUTOS CWP2895788 10/19/12 10/19/13 COMBINED SINGLE LIMIT Ea accident 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ • X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CU2695790 10/19/12 10/19/13 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 DED I X I RETENTION $ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? ❑ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WC STATU- OTH- 3 E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) AS RESPECTS: CONTRACT #09 -004 STREET SWEEPING, #09 -006 VACTORING - CITY OF SPOKANE VALLEY SHALL BE LISTED AS ADDITIONAL INSURED AS GRANTED BY THE POLICY. FORMS ATTACHED. CITY OF THE SPOKANE VALLEY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 11707 E SPRAGUE AVE., STE 106 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SPOKANE VALLEY, WA 99206 AUTHORIZED REPRESENTATIVE 000163 The ACORD name and logo are registered marks of ACORD © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) I IIIIIII III IIIIIII IIII VIII IIIIII IIII VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIII •cveo2srs/0000n/ovoarororo/o• Verify Workers' Comp Premium Status - Employer Liability Certificate Washington State Department of Labor and Industries Department of Labor and Industries Employer Liability Certificate Date: 10/23/2012 UBI #: 602 346 432 Business Name: AAA SWEEPING LLC Legal Business Name: AAA SWEEPING LLC Account #: 500,499 -04 'Doing Business As' Name: AAA SWEEPING LLC Page 1 of 1 Employer Liability Certificate Estimated Workers Reported: Quarter 2 of Year 2012 "11 to 20 Workers" (See Description Below) Workers' Comp Premium Status: Account is current. Firm has voluntarily reported and paid their premiums. Licensed Contractor? License: Expire Date: Yes AAASWL *963CA 2/1/2014 Account Representative: T2 / KATHY WITHERS (360)902 -4829 - Email: WITE235 @lni.wa.gov What does "Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter. A single 480 hour position may be filled by one person, or several part time workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to be due. Industrial insurance accounts have no policy periods, cancellation dates, limitations of coverage or waiver of subrogation (See RCW 51.12.050 and 51.16.190). https: // fortress .wa.gov /InilcrpsilAcctlnfoPrint. aspx ?AccountId= 50049904 &AccountMana... 10/23/2012